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Hantavirus

Hantavirus. Overview. Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control . The Organism. Hantaviruses. Family Bunyaviridae RNA virus Genus Hantavirus Only genus not arthropod-borne Transmitted by murid rodents

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Hantavirus

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  1. Hantavirus

  2. Overview • Organism • History • Epidemiology • Transmission • Disease in Humans • Disease in Animals • Prevention and Control Center for Food Security and Public Health Iowa State University - 2004

  3. The Organism

  4. Hantaviruses • Family Bunyaviridae • RNA virus • Genus Hantavirus • Only genus not arthropod-borne • Transmitted by murid rodents • More than 25 hantavirus species Center for Food Security and Public Health Iowa State University - 2004

  5. Hantaviruses • Lipid envelope • Deactivated by ordinary disinfectants • A “viral hemorrhagic fever” • Hantavirus Pulmonary Syndrome (HPS) • Hemorrhagic Fever with Renal Syndrome (HFRS) Center for Food Security and Public Health Iowa State University - 2004

  6. Hantaviruses in the Old World Center for Food Security and Public Health Iowa State University - 2004

  7. Hantaviruses in the New World Center for Food Security and Public Health Iowa State University - 2004

  8. Hantaviruses in the New World *Numerous other hantaviruses have been identified but not linked to human disease Center for Food Security and Public Health Iowa State University - 2004

  9. New World Hantaviruses Maciel Necromys benefactus Hu39694 Unknown Host Lechiguanas Oligoryzomys flavescens Pergamino Akodon azarae New York Peromyscus leucopus Sin Nombre Peromyscus maniculatus Prospect Hill Microtus pennsylvanicus Muleshoe Sigmodon hispidus Bloodland Lake Microtus ochrogaster Isla Vista Microtus californicus Bayou Oryzomys palustris Black Creek Canal Sigmodon hispidus El Moro Canyon Reithrodontomys megalotis Rio Segundo Reithrodontomys mexicanus Caño Delgadito Sigmodon alstoni Laguna Negra Calomys laucha Juquitiba Unknown Host Rio Mamore Oligoryzomys microtis Orán Oligoryzomys longicaudatus Bermejo Oligoryzomys chacoensis Andes Oligoryzomys longicaudatus Center for Food Security and Public Health Iowa State University - 2004

  10. History

  11. Hantaviruses in Our Past • American Civil War • World Wars I and II • 1913, 1932 • Russia reported cases • 1934 • Sweden - Nephropathia Endemica • 1950’s • Reports of Korean Hemorrhagic Fever Center for Food Security and Public Health Iowa State University - 2004

  12. Hemorrhagic Fever with Renal Syndrome (HFRS) • 1951-1954: Korean War • 3,200 U.N. troops develop disease • Hantaan River separated N. & S. Korea • 1977 • Hantaan agent isolated and characterized • 1990: 94% of serum samples from soldiers in 1950’s had antibodies • 1979 • Seoul virus found in Japan and Europe Center for Food Security and Public Health Iowa State University - 2004

  13. U.S.: Four Corners Outbreak Center for Food Security and Public Health Iowa State University - 2004

  14. The Four Corners Outbreak • May 1993 • First clinical case • Abrupt fever, myalgia, pulmonary edema • June 1993 • 12 fatalities • Unexplained Adult Respiratory Distress Syndrome (ARDS) • Sera cross-reacted with Hantaan, Seoul, Puumala virus • Rodents trapped - deer mouse main reservoir Center for Food Security and Public Health Iowa State University - 2004

  15. The Four Corners Outbreak • Winter and spring 1993 • Drought for several years followed by snow and rain • Vegetation blossomed and rodent population grew tenfold • Virus isolated and named • Sin Nombre Virus (SNV) • Newly emerging virus has been present since 1959 • 38 year old Utah man Center for Food Security and Public Health Iowa State University - 2004

  16. Epidemic Curve of Four Corners Outbreak Center for Food Security and Public Health Iowa State University - 2004

  17. Recent Cases • May 2003: Montana • Three cases • Two deaths • Contracted virus from rodents in home • First cases since fall of 2001 • Overall cases in Montana • Virus first appeared in state in 1993 • 20 cases • 5 deaths Center for Food Security and Public Health Iowa State University - 2004

  18. Epidemiology

  19. Common Rodent Reservoirs • United States, except the Southeast • Deer mouse (Peromyscus maniculatus) • Southeast United States • Cotton rat (Sigmodon hispidus) • Rice rat (Oryzomys palustris) • Eastern • White-footed mouse (Peromyscusleucopus) • House mouse not a carrier! Center for Food Security and Public Health Iowa State University - 2004

  20. Deer Mouse • Peromyscus maniculatus L.L. Masters • Cotton Rat • Sigmodon hispidus • House Mouse • Mus musculus Center for Food Security and Public Health Iowa State University - 2004

  21. Center for Food Security and Public Health Iowa State University - 2004

  22. Hantaan Virus Reservoir Striped field mouseApodemus agrarius Center for Food Security and Public Health Iowa State University - 2004

  23. Location of HPS Cases by Virus Types: July 6, 2004 Total Cases (N=366 in 31 States) Although serologically confirmed as HPS, sequence data are not available for all cases. For non-sequenced cases, the specific infecting hantavirus is assumed to be that corresponding with the known rodent reservoir in the area of probable exposure. Center for Food Security and Public Health Iowa State University - 2004

  24. Distribution* of Peromyscus maniculatus and HPS Cases as of July 6, 2004 Total Cases (N=366 in 31 States) *Rodent distributions from: Burt WH, Grossenheider RP. A Field Guide to the Mammals. 3rd ed. New York, New York. Houghton Mifflin Company. 1980 Center for Food Security and Public Health Iowa State University - 2004

  25. Distribution* of Oryzomys palustris andLocation of HPS Cases as of July 6, 2004 Total Cases (N=366 in 31 States) *Rodent distributions from: Burt WH, Grossenheider RP. A Field Guide to the Mammals. 3rd ed. New York, New York. Houghton Mifflin Company. 1980 Center for Food Security and Public Health Iowa State University - 2004

  26. Distribution* of Peromyscus leucopus andHPS Cases as of July 6, 2004 Total Cases (N=366 in 31 States) *Rodent distributions from: Burt WH, Grossenheider RP. A Field Guide to the Mammals. 3rd ed. New York, New York. Houghton Mifflin Company. 1980 Center for Food Security and Public Health Iowa State University - 2004

  27. Distribution* of Sigmodon hispidus andHPS Cases as of July 6, 2004 Total Cases (N=366 in 31 States) *Rodent distributions from: Burt WH, Grossenheider RP. A Field Guide to the Mammals. 3rd ed. New York, New York. Houghton Mifflin Company. 1980 Center for Food Security and Public Health Iowa State University - 2004

  28. HPS Cases by State of Residence U.S.: July 6, 2004 Total Cases (N=366 in 31 States) Center for Food Security and Public Health Iowa State University - 2004

  29. HPS Case Count • North & South America • 1500 cases • United States and Canada • Sin Nombre Virus • Majority of cases • Others implicated • Andes, Monongahela, Black Creek Canal, Bayou, and New York viruses • Rodent-to-human transmission Center for Food Security and Public Health Iowa State University - 2004

  30. HPS Case Count, U.S. • United States • 31 states have reported cases • Occur throughout the year • More common in spring-summer • 75% of patients reside in rural areas • 62% male; 38% female • Mean age of confirmed case is 37 • Mortality rate 38% • Notifiable disease Center for Food Security and Public Health Iowa State University - 2004

  31. Non-Sin Nombre HPS Viruses • Black Creek Canal Virus • Cotton rat (Sigmodon hispidus) • One case in a Florida man • Bayou Virus • Rice rat (Oryzomys palustris) • 4 cases in Louisiana, Texas • New York-1 Virus • Deer mouse (P. maniculatus), white footed mouse (P. leucopus) • 2 cases in New York Center for Food Security and Public Health Iowa State University - 2004

  32. 69% (48/70) 19% (13/70) 9% (6/70) 4% (3/70) 9% (6/70) Peridomestic exposure Peridomestic & occupational exposure Peridomestic & recreational exposure Occupational exposure Entering/cleaning rodent-infested structures Rodent Exposures and HPS 70 confirmed HPS cases Armstrong, L.R. et al., JID 1995; 172 (October) Center for Food Security and Public Health Iowa State University - 2004

  33. Risk of Contracting HPS • Relatively low • Contact with rodent excrement puts you at greatest risk • Cleaning a rodent infested dwelling • Opening or cleaning buildings that have been closed for a while • Especially over winter Center for Food Security and Public Health Iowa State University - 2004

  34. Risk of Contracting HPS • Work, play, or live in closed spaces where rodents are actively living • Hikers and campers • Construction and utility workers • Enter crawl spaces under buildings • No serological evidence in 522 samples • Traveling to and within hantavirus areas is not a risk factor Center for Food Security and Public Health Iowa State University - 2004

  35. HPS U.S. Descriptive Demographic Statistics: July 6, 2003 N 366 (100%) Male 227 (62%) 139 (38%) Female White 284 (78%) American Indian 71 ( 19%) Black 6 ( 2%) 3 ( 1%) Asian Hispanic 45 (12%) 135 (37%) Dead Age (years) Mean=37 [10-75] Center for Food Security and Public Health Iowa State University - 2004

  36. Reported Cases 60 55 50 45 40 35 30 25 20 15 10 5 0 1995 1996 1997 1998 1999 2000 2001 2002 Year Center for Food Security and Public Health Iowa State University - 2004

  37. November 1998 Center for Food Security and Public Health Iowa State University - 2004

  38. HFRS • Worldwide • 150,000–200,000 cases/yr • Korean Hemorrhagic Fever • South Korea • 300-700 cases annually • Eastern China • ~100,000 cases annually • Outbreaks linked to contact with field rodents during planting and harvesting of crops Center for Food Security and Public Health Iowa State University - 2004

  39. Transmission

  40. Transmission of Hantaviruses Chronically infected rodent Horizontal transmission of infection between same species by contact Virus is present in aerosolized excreta, particularly urine Secondary aerosols, mucous membrane contact, and skin breaches are also a consideration Center for Food Security and Public Health Iowa State University - 2004

  41. Transmission of Hantaviruses • Non-rodent animals may test positive • Do not excrete viral particles • Some species may introduce rodents into domestic setting • Person-to-person transmission rare • Not through blood transfusion or vectors • Southern Argentina case • Lab acquired (several cases) Center for Food Security and Public Health Iowa State University - 2004

  42. Disease in Humans

  43. Clinical Signs of HPS • Incubation period • 14-17 days • Early stage • Fatigue, fever, myalgia, headache • Lasts 3-5 days • Half of the patients experience headaches, dizziness, chills, nausea, vomiting, diarrhea, abdominal pain Center for Food Security and Public Health Iowa State University - 2004

  44. Clinical Signs of HPS • Later stage • 4 to 10 days after initial signs • Coughing and shortness of breath • Rapidly progressive, non-cardiogenic pulmonary edema and severe hypotension • Hospitalization and ventilation required usually within 24 hours Center for Food Security and Public Health Iowa State University - 2004

  45. Clinical Signs of HPS • Tachypnea, tachycardia • Hypotension • Crackles or rales on lung examination • Lowered albumin, elevated hematocrit • Elevated WBC count • Platelet count below 150,000 units Center for Food Security and Public Health Iowa State University - 2004

  46. HPS Radiographic Findings • Bilateral interstitial infiltrates • Moderate to rapid progression • Bilateral alveolar infiltrates • Pleural effusion • Normal heart size Center for Food Security and Public Health Iowa State University - 2004

  47. Radiographic Progression of HPS May 27, 1993 May 30, 1993 May 31, 1993 Source: Dr. L. Ketai Center for Food Security and Public Health Iowa State University - 2004

  48. HPS National Surveillance Inclusion Criteria • Healthy person with febrile illness; • Unexplained acute respiratory distress syndrome OR bilateral interstitial lung infiltrates • Supplemental oxygen OR death from unexplained respiratory illness • AND noncardiogenic pulmonary edema at autopsy • AND no identifiable, specific cause of death Center for Food Security and Public Health Iowa State University - 2004

  49. HPS National Surveillance Exclusion Criteria • Predisposing underlying medical condition • Acute illness that explains the respiratory disease Center for Food Security and Public Health Iowa State University - 2004

  50. HPS National Surveillance • Confirmation requires meeting all inclusion and exclusion criteria • Plus laboratory confirmation • Positive serology • Positive PCR • Positive IHC Center for Food Security and Public Health Iowa State University - 2004

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